“More Than Words”

The following information relating to “More Than Words” and children with Autism was taken from Latrobe University website address:
http://www.latrobe.edu.au/hcs/projects/autism/hanen_program.htm

More Than Words is an intensive training program specifically designed for parents of pre-school children with autism. It is designed on the notion that parents are their children’s best teachers. Research has demonstrated that family factors are considered one of the primary predictors of outcome for children with a variety of disabilities (Shonkoff, Hauser-Cram, Krauss, & Upshur, 1992).

AUTISM AND MORE THAN WORDS

The More Than Words program is not designed to replace one-on-one therapy. It is designed as an adjunct to therapy: another avenue the Speech Pathologist and parents can explore to enhance the opportunities for the child with autism to learn to communicate effectively.
More Than Words provides support, education and practical skills for parents of children with autism. It educates them on how they can support their child’s communication development by being more responsive to their children and aware of generating opportunities in which their children will be motivated to communicate. When parents implement these skills, it allows intervention to occur on a regular basis during all daily activities. This results in frequent and intensive intervention which has been deemed to have the most successful outcome (Dawson & Osterling, 1997).
According to Prizant (1998) More Than Words blends two evidence-based theoretical frameworks; the social-pragmatic notion that children with autism learn to communicate by being active participants in meaningful life activities and Applied Behavioural Analysis. Research has indicated children with autism benefit from both approaches (Green, 1996, McEachin, Smith & Lovaas, 1993, Greenspan, 1997).

IMPLEMENTATION OF MORE THAN WORDS

The program format involves eight weekly classes for parents and four in-home videotaping sessions of the parents interacting with their children. The classes are designed to accommodate different adult learning styles through providing information in both interactive and practical sessions. The in-home videotaping provides an opportunity for parents to apply what they have learnt during the classes to interactions with their own child and to receive constructive feedback. Each parent is given a specific plan to try at home with his or her child during each class.
The program educates parents on the implementation of the following evidence-based strategies:
1. Give the child a reason to communicate by modifying the environment to motivate the child and then wait.
For example: The parent can blow bubbles and then give the closed container to their child and wait for the child to ask for more using the communicative mode appropriate for their stage (e.g., alternating gaze between parent and object, echoing an adult model or using a phrase). This utilises a naturalistic environment. According to Delprato (2001), children with autism display better receptive language and speech production in a naturalistic environment rather than an adult directed environment (Delprato, 2001). Koegel et al., (1998) suggest that naturalistic approaches result in greater generalisation of language gains in all situations and environments.
2. Create structure and Predictability in the Child’s Life.
More Than Words directs parents on how to achieve structure and predictability in their child’s life (e.g., routine) (Sussman, 2002). Yoder (1995) demonstrated that routines can effectively promote longer utterances in children with developmental delays. Autism programs generally emphasise the importance of routine to foster language development in children with autism (Dawson & Osterling, 1997).
3. Follow the Child’s lead.
This is characterised as the parent allowing the child to choose their topic of interest. The parent then responds to the child’s topic with comments that contain developmentally appropriate language structures (Sussman, 2002). Research has shown that joint attention (one of the core deficits of children with autism) develops when the adult notices a child’s interest and shares that interest (Bruner, 1981).
There has been research to demonstrate that parents promote communication development when using a facilitative approach with children with autism (Nelson & Camarata, 1996). Additionally, for verbal children with autism, a facilitative approach has been found to result in increased attempts to initiate conversations, e.g., by asking questions, and the production of more varied language and longer utterances (Mirenda & Donnlelann, 1986).
4. Make a connection using “People games” and R.O.C.K.
The program educates parents on how to create structured, fun and predictable games that appeal to their child using R.O.C.K. This acronym involves the following (Sussman, 2002):
R: Repeat what you say and do.
O: Create opportunities for your child to take a turn.
C: Cue your child to take their turn.
K: Keep it fun and keep it going.
Research has demonstrated that when pre-verbal children engage in “people games”, e.g., peekaboo, they learn both the rules of the game and their role as an initiator and responder (Ratner & Bruner, 1978). The turn-taking in these games also serves as proto-conversations. They encourage social reciprocity, motivate the child to maintain eye contact and develop joint attention (Ratner & Bruner, 1978).
5. Help your child understand what you say by: “Say less, Stress, Go slow and Show”
This strategy focuses on adjusting the way parents communicate with their child with autism to make it easier for the child to comprehend what they say. This is achieved by simplifying sentences, talking slower, stressing key words and using gestures to label what they are talking about (Sussman, 2002). Research demonstrates that the way a parent speaks to their child with autism is the most important factor in their child extracting meaning from the language (Harris, Jones, Brookes & Grant 1986). Furthermore, the spoken word is most meaningful for the child with autism when they are showing interest in what it refers to (Siller & Sigman, 2002).

RECEPTIVE LANGUAGE AND MORE THAN WORDS

• Naturalistic environment: Assists children with autism to display improved overall comprehension than an adult directed environment (Delprato, 2001).
• Routine: Increases the opportunity for a child with autism to understand their environment and the language that is used in the environment (Paul, 2001).
• Modifying the nature of language presentation to the child, e.g., saying less, stressing key words, speaking slowly and providing visual cues assists overall comprehension (Harris et al, 1986; Siller & Sigman, 2002).
• Use of “people games”: The structure and predictability of these games increases the child’s opportunity to understand the language that accompanies it (Paul, 2001).

EXPRESSIVE LANGUAGE AND MORE THAN WORDS

• Providing the child with a reason to communicate by modifying the environment to motivate the child and then waiting for a response has been found to effectively facilitate meaningful speech output from the child if they are at a verbal level (Delprato, 2001).
• Use of routines has been found to be successful in fostering language development in children with autism and promoting longer utterances (Dawson & Osterling, 1997; Yoder, 1995).
• Following the child’s lead has been found to result in increased attempts to initiate conversations (e.g., by asking questions) and the production more varied language and longer utterances (Mirenda & Donnlelann, 1986).
• Help your child understand what you say by saying less, stressing key words, speaking slowly and using visual cues is likely to help the child better comprehend what the parent has said. A language model is likely to assist the child to learn language and for speech production (Paul, 2001).

PRAGMATICS AND MORE THAN WORDS

• Follow the child’s lead: Research has shown that joint attention (one of the core deficits of children with autism) develops when the adult notices a child’s interest and shares that interest (Bruner, 1981).
• Make a connection using “people games” and R.O.C.K: The structure of these games when using R.O.C.K promotes turn taking behaviours, encourages social reciprocity, motivates the child to maintain eye contact and develops joint attention (Ratner & Bruner, 1978).

PROFESSIONAL TRAINING:

Speech Pathologists need to complete the following training workshops to enable them to conduct the More Than Words program with parents of children with autism:

• Level 1 Hanen Certification Workshop: Three day work shop for Speech Pathologists on It Takes Two to Talk-The Hanen Program for Parents.
• Advanced Hanen Certification Workshop: Three day workshop for Speech Pathologists on More Than Words.

For information regarding workshop locations, dates and costs refer to the Hanen website: http://www.hanen.org.
Alternatively, Speech Pathologists can refer the parents of a child with autism to a More Than Words workshop conducted by a Hanen certified Speech Pathologist in their local area.

ADVANTAGES OF MORE THAN WORDS

There are numerous advantages to using More Than Words, these include:

• It utilises strategies that have an evidence base.
• Intervention for the child with autism does not cease when the program ceases as it does in traditional therapy. The program aims to equip parents with the skills required to continue intervention over a long term basis in all situations.

DISADVANTAGES OF MORE THAN WORDS

The disadvantages of More Than Words include:

• Speech Pathologists are required to have advanced Hanen certification to conduct a More Than Words program.

Programs are not conducted in every town; therefore accessibility for rural families may be an issue.